When I got back to the car, I looked closer. In tiny letters, the box said “Homeopathic”! I guess I should have expected that in a heath food store, there would be homeopathic remedies, but I didn’t realize that they would ONLY have quack medicines. Readers of this blog are probably familiar with the problem with homeopathy. Most homeopathic medicines are diluted down so much that they contain few or no molecules of the active ingredient, and so they are literally just drinking water. In the case of these pills I bought, there is a long list of inactive ingredients, and just a tiny amount of the Pelargonium sidoides plant, a South African herb that MIGHT have some effect on reducing cold symptoms—although the medical studies are inconclusive, and most colds go away as our immune systems take care of the viral infection.

The claims of homeopathy have been tested over and over again, and none has passed muster. In 2005, the premier British medical journal The Lancet published an analysis of 220 studies about homeopathy, half of them conventional studies of medicines, and half of them of controlled homeopathic experiments. They found no evidence that homeopathy had any real value except as a placebo. In 2006, the European Journal of Cancer surveyed 6 studies, and found homeopathy had no effect (Milazzo et al., 2006). Even studies by homeopaths themselves often show that their products have no significant effect, despite their biases to prove otherwise.

In January 2010, a group of British skeptics decided to stage an event to show the uselessness of homeopathic remedies. They planned a “homeopathic overdose” day on Jan. 30, where they would take hundreds of times the recommended dose of homeopathic remedies to “commit suicide”. If homeopathic remedies were real drugs, such overdoses would indeed have made these people sick, or killed them. Of course, nothing adverse happened to them—except that some of them had to go to the bathroom more often from consuming so much water. Their protest was an effort to expose the fraudulent nature of  homeopathic remedies sold in British drugstores to the tune of £12 million worth of these worthless “remedies” between 2005 and 2008. Since the original stunt, groups in America and Australia have staged similar events to publicize the worthlessness of homeopathy.

In the United States, there is no national medical system fully in place yet, but homeopathy is not covered by most private medical insurance providers. About $3.1 billion were spent on homeopathic medicines in 2007, and about 2% of the U.S.  population seeks homeopathic treatment each year. Homeopathic remedies are still regulated as drugs for purity by the FDA, although the FDA does not endorse their medicinal qualities. However, the FDA considers most of homeopathic drugs harmless, because they are so diluted that they have no real active ingredients left. (The FDA is not empowered to tell consumers whether the drugs are worthless or a waste of money, just whether they are safe or not).

I should not have been surprised that an organic food store would have expensive but worthless homeopathic products on their shelves. Unfortunately, there are many mainstream grocery stores and drugstores that carry both homeopathic “medicines” next to legitimate medicines—and the consumer needs to look the packaging over carefully to make sure that it is really an FDA-approved drug based on scientific research, and not the product of some homeopathic con game. Caveat emptor!

As a coda to the story, I went to a conventional drug store immediately after I realized the health food store “medicine” was homeopathic—and bought 20 tablets of a real antihistamine-decongestant-pain reliever (for just $6), and took some of those. I felt fine the rest of the afternoon. And I saved the receipt from the health food chain, so I got my $17 back.

On Friday, October 24, 2009, a California Court of Appeals vindicated Dr. Bruce Flamm, an OBGYN physician and professor at the University of California, Riverside, and member of the Skeptics Society, by throwing out a defamation lawsuit filed against him by a man who claimed to have proven that prayer can increase pregnancy rates in women trying to conceive.

Back in 2001, the Journal of Reproductive Medicine published a study by three Columbia University researchers claiming that prayer for women undergoing in-vitro fertilization resulted in a pregnancy rate of 50 percent, double that of women who did not receive prayer (i.e., a 100% increase in pregnancy rates!). Media coverage was extensive. ABC News medical correspondent Dr. Timothy Johnson, for example, reported, “A new study on the power of prayer over pregnancy reports surprising results; but many physicians remain skeptical.” One of those skeptics was a University of California Clinical Professor of Gynecology and Obstetrics named Bruce Flamm, who not only found numerous methodological errors in the experiment, but also discovered that one of the study’s authors, Daniel Wirth (AKA “John Wayne Truelove”), is not an M.D., but an M.S. in parapsychology who has since been indicted on felony charges for mail fraud and theft, for which he pled guilty. The other two authors have refused comment, and after three years of inquires from Flamm the journal removed the study from its website and Columbia University launched an investigation.

What they discovered, thanks to the vigilance of Dr. Flamm, was that Cha’s other co-author, Columbia University’s Rogerio Lobo, later revealed that he had not participated in the research and withdrew his name from the published findings. Even with one of his co-authors in federal prison and the other disgraced, Korean fertility specialist Kwang Yul Cha stood by the results of was is essentially a supernatural claim in that the presumption is that the deity intervened on behalf of infertile women to help them conceive. One wonders why the prayers do not seem to work in the other direction; that is, all those women who, due to alcohol or other external influences, engaged in sexual activity with no intention of conceiving and thus, over the course of the next several days, prayed like mad for pregnancy prevention, to no avail. But I digress…

Angered by Dr. Flamm’s skeptical persistence, Cha eventually filed a defamation lawsuit against Flamm, especially after he published several articles questioning the validity of the original pregnancy study. The lawsuit, filed in Los Angeles Superior Court in August 2007, was thrown out of court in April, 2008. However, in June, 2008 Cha took the case to the California Appellate Court. Finally, on October 24, 2009, the Court of Appeals, “affirmed in full” the Superior Court decision and thus ruled that Superior Court Judge James Dunn had acted appropriately in tossing out the lawsuit.

In response to the ruling, Dr. Flamm issued the following statement:

Today’s ruling is a victory for science and evidence-based medicine. Scientists must be allowed to question bizarre claims. Cha’s mysterious study was designed and allegedly conducted by a man who turned out to be a criminal with a 20-year history of fraud. A criminal who steals the identities of dead children to obtain bank loans and passports is not a trustworthy source of research data. Cha could have simply admitted this obvious fact but instead he hired a team of lawyers to punish me for voicing my opinions. Physicians should debate their opinions in medical journals, not in courts of law. Judges have better things to do with their time and taxpayers have better things to do with their money.

Amen, brother! And congratulations Dr. Flamm, on a cause well chosen and a battle well fought. Your stamina, persistence, and skeptical vigilance are to be commended. We honor you.

• FOLLOW MICHAEL SHERMER ON TWITTER •

That Mitchell and Webb Look: Homeopathic A&E

But, would they still have the ammo if the story had been told a different way? What if the researchers hadn’t used the words “neural stem cells” in the title of their paper? Maybe a tale of reckless research methods would be better for everyone.

Here are the facts as we know them:
1)    The boy received injections of fetal neural cells.
2)    The boy has tumors.
3)    The tumors are derived from the injected cells.

It looks like an open and shut case against this therapy treatment, but it’s not. Instead, it a very complex situation that is also a harbinger of the trouble to come without proper regulation.

First, the boy was being treated for a genetic disorder called ataxia telangiectasia in which the area of the brain responsible for movement deteriorates over time until the individual is no longer able to move and eventually dies. Exactly why the boy’s parents enrolled their child in the therapy trial is unclear; aside from the hope that this treatment, any treatment would help their ailing son.

Considering that the disorder is genetic, there is no reason to expect that injecting stem cells would be beneficial. There is no evidence that injected stem cells would migrate to the deteriorating locations, and once there, whether they would or even could act to replace the problematic tissue. According to Wired Science, the boy’s condition did not improve, so it can be inferred that the cells did not fix the implicated brain tissue.

The second issue here is the legitimacy of using fetal stem cells in the treatment of brain disorders and injuries. The cells used in this study were from the neural tissue of 8-12 week old aborted fetuses. At this stage of development, it is assumed that the cells within different tissues have already begun the differentiation process. Once differentiation has occurred it is unlikely that stem cells from the brain will turn into liver cells. By working with differentiated cells, researchers hope to have tighter control of the activity of the cells.

However, stem cells have a propensity to divide. In this manner they are very similar to cancer cells. In fact, there is evidence that points to stem cells as the culprits in certain kinds of cancer. The injected fetal cells were expected to divide (hopefully to create helpful neural tissue), but the scientists had no way of knowing for certain where the division would lead.

The final, and possibly the most crucial, question regarding this case is whether or not the cells were actually neural stem cells. Dr. Evan Y. Snyder, Professor at the Burnham Institute for Medical Research, and Director of the Program in Stem Cell & Regenerative Biology and the Stem Cell Research Center, whose lab was the first to isolate human neural stem cells way back in 1998, is familiar with the Russian scientists who ran the stem cell study. His analysis is that their therapeutic protocol lacked methodological rigor.

“Although the Russians claim to be using “neural stem cells”, they are not. They essentially take whole fetal brain, put in a Cuisinart, and inject it uncharacterized as a graft slurry,” wrote Dr. Snyder on The-Scientist.com.

When I asked him how he knew so much about their method, he said that he visited the Russian research site when they were initiating their investigations. He spoke with the surgeons about their methods and how the cells were provided to them.

“We told them they were doing it wrong. They found our procedures too tedious.”

Dr. Snyder and his colleagues have a paper in revision at the New England Journal of Medicine in which they analyzed the cells used in a similar case from the same group, and concluded that they were not likely to be neural stem cells.

“I am actually disappointed that the Israeli scientists who analyzed this material did not do a more careful characterization of the actual donor-derived tissue and cells. Had they done so, they would have known, as well, that what they saw could not have come from a rigorously defined neural stem cell,” says Dr. Snyder.

It is therefore possible that Israeli report is in fact inaccurate in its attribution of the tumor to “neural stem cells.” They found the abnormal growth to be made up of several different cell types, which is unusual for cancerous tumors. The variety of cell types, making up a neoplasm, is more in line with the development of undifferentiated stem cells than what would be expected from the injection of truly differentiated neural stem cells.

“This case has no bearing whatsoever on the legitimate biology and uses of stem cells, particularly neural stem cells,” wrote Dr. Snyder.

He further elaborated by saying, “The Israeli authors were not sufficiently skeptical or inquisitive enough… True normal neural stem cells likely do not have the capacity, without a series of mutations, to give rise to neoplasms. I do not believe it is part of their biology.”

Taken as a whole, this is a tragic story, which can hopefully be taken as a lesson. Proper regulation, not cessation, of stem cell therapy research will reduce the number of casualties from improper research methods. It will legitimize the research and reduce the number of rogue laboratories in foreign countries where people are almost certain to lose their lives in the search for a cure. And, it will speed the process of finding therapies that actually work.

“Acupuncture Stops Headaches, But ‘Faked’ Treatments Work Almost As Well”

Really? Interesting headline, I thought to myself, and proceeded to ingest the release. I have a love-hate relationship with acupuncture, you see. I don’t believe that it actually works. The evidence certainly hasn’t piled up in acupuncture’s clinical favor.  Yet, I have a friend or two (who I love dearly) who attend acupuncture school, and plan to make the craft their careers. So, I had to read on… maybe there is proof to my friends’ claims.

The release discussed two clinical reviews: one related to acupuncture and migraines, the other to acupuncture and tension headaches. The criteria for inclusion of trials in the review seemed fair enough. The reviewers looked at all randomized studies with at least two month long observation periods comparing acupuncture treatment to control, sham treatment or another intervening treatment, like massage or relaxation.

The review of studies related to tension headaches found that acupuncture was better than treatment for acute headaches or simple routine care, and that real acupuncture was better (marginally) than sham acupuncture. Interestingly, studies involving other treatments were considered too flawed to allow any conclusions to be drawn. I find this unfortunate because one of the main questions related to acupuncture is whether the relaxation and skin palpation that takes place during the process of acupuncture might have something to do with the perceived results.

The migraine review concluded that acupuncture was helpful to migraine sufferers, but that real acupuncture was no better than sham acupuncture. It is even questionable whether needle placement is important for positive results. This suggests that there are other processes at work in the migraine mitigation.

Overall, the suggestion of the authors is that acupuncture is a useful addition to any migraine or tension headache treatment regime. Alright, I thought, at least it doesn’t appear to have any negative effects (according to the reviews), and it might be better than dealing with the side-effects of drug-treatments.

Then I checked the authors’ declaration of interest:

“This review includes trials in which some of the reviewers were involved, as follows: Allais 2002 – Gianni Allais; Jena 2008 – Benno Brinkhaus; Linde K 2005 – Benno Brinkhaus and Klaus Linde; Streng 2006 – Klaus Linde; and Vickers 2004 – Andrew Vickers. These trials were reviewed by at least two other members of the review team. Gianni Allais, Benno Brinkhaus and Adrian White use acupuncture in their clinical work. Gianni Allais receives fees for teaching acupuncture in private schools. Klaus Linde has received travel reimbursement and, in two cases, fees from acupuncture societies (British, German and Spanish Medical Acupuncture Societies; Society of Acupuncture Research) for speaking about research at conferences. Eric Manheimer and Andrew Vickers both received an honorarium for preparing and delivering presentations on acupuncture research at the 2007 meeting of the Society for Acupuncture Research. Adrian White is employed by the British Medical Acupuncture Society as journal editor and has received fees and travel reimbursements for lecturing on acupuncture on several occasions. Benno Brinkhaus has received travel reimbursement and fees for presenting research findings at meetings of acupuncture societies (British, German and Spanish Medical Acupuncture Societies).”

Heh. They’ve all got a vested interest in the outcome of these reviews. However, who better to review acupuncture research than acupuncturists? The experts in the field.

In my view, there is a conflict of interest here, which should be better conveyed to the public. What do you think?

From the GTS Kombucha website:

“In 1995, founder GT Dave’s mom, Laraine Dave, had been diagnosed with a rare form of breast cancer with a trajectory of illness known to move quickly to the lymph and bones. When she was diagnosed, doctors held out little hope for her given the aggressive type of cancer and its advanced stage. But to the surprise of everyone, her cancerous cells were found to be dormant with no metastasis. Her physicians were baffled and asked what she was doing that others in her situation were perhaps not doing. The only thing she could think of was that she had been drinking homemade Kombucha every day for the last couple of years.”

Anecdotal evidence is never convincing to a skeptic, so I’ve remained skeptical about Kombucha’s health providing properties even though several of them profess its wonders.

First, what is Kombucha? It is a fermented, sweetened tea (either black or green is normally used) containing what’s technically known as a zoogleal mat of various symbiotic bacteria and yeast species. I prefer to call the mat “the octopus” in reference to the way it attacks your face when drinking straight from the bottle. Most people refer to it simply as a “mushroom”.

Research has identified the bacteria as belonging to the genus Acetobacter, which oxidize sugars or alcohols metabolizing acetic acid as a bi-product. These bacteria are used widely in the food industry, especially in the production of vinegars from wines and spirits, and have been ingested by humans for hundreds of years. So, if not healthful, they certainly aren’t known to be widely harmful to humans.

The yeast are from several different genera, including but not limited to Brettanomyces bruxellensis, Candida stellata, Schizosaccharomyces pombe, Torulaspora delbrueckii and Zygosaccharomyces bailii. Several of these species are used in either the brewing of beer or the fermentation of wine. All told, the combinations of bacterial and yeast species should have little negative effect on a healthy individual, and in fact more and more research suggests that ingestion of so-called pro-biotics might actually be beneficial.

Ok, so Kombucha has been around a while. Since 250 BC or so. It was first used by the Chinese, and made its way into Russia in the 1800’s. Since then it has grown in popularity, mostly as a home-brewed concoction. However, more recently it has become a commercially distributed product, which has allowed it to reach a wider segment of the population.

Most of the health benefits of Kombucha are not clinically supported in humans, but rather anecdotal. There has been limited conflicting research in mice and rats. While the fermented tea seems to have antioxidant and immunomodulatory activity in rats (likely due to the polyphenols present in the tea used to create the Kombucha), it has also been shown to increase the size of both the liver and spleen in mice. Significantly, the home-brewed variety has been linked with several health issues in people, ranging from bacterial infections to liver damage and to death. That said, Kombucha sold commercially is probably safer than homemade. However, due to processing differences, commercial Kombucha isn’t likely to have as wide a variety of bacterial and/or yeast species making up its zooglea.

In conclusion, the research and evidence that is available to date is not sufficient for the medical community to endorse the consumption of Kombucha for health related purposes. Until the proper studies are done, Kombucha will simply remain an interesting drink with a serious cult following.

Unchecked by the scientific method, the Taoist origin of TCM, which depends on intuition and common sense, spawned some ridiculous concepts, which can only be described as naive imagination. It is believed that eating frogs which live in cool ponds must have a cooling effect on the body, while eating a lung shaped plant could be good for people suffering with tuberculosis. The latter is taken seriously for the shapes of natural objects are not mere cosmic accidents and must therefore have some intrinsic medicinal value associated with the shape of the organs of our body. Walnuts look like our brain – so it must be good brain food. Lima beans and cashew nuts look like kidneys so they are good for guess what? The longan berry (Dimocarpus longana aka “dragon eye”),  which really looks like an eyeball when peeled, must be good for vision. The panacea elixir extraordinaire of TCM is the ginseng root which can allegedly strengthen the heart and nervous system and shore up mental and physical vitality, build up resistance to diseases and even cure cancer. How? Because it looks like a complete human! Look at any advertisement or packaging for ginseng root, it is always posed to look like a stick figure human drawn by every aspiring kindergarten Picasso.  Ginseng in Chinese is “ren xing” meaning “human heart.” With such a name and such a shape, how can you go wrong?

Many a Chinese schoolboy in Hong Kong, Singapore and Malaysia can attest to how many stew pig brains he had been fed in preparation to take the SAT or the infamous Cambridge Overseas School Certificate “O” and “A”-level exams required for admissions to some of the most prestigious universities in the US, UK, Canada and Australia. (How did you think a kid from Borneo got into MIT?) Every herbalist will have a good stock of deer sinews for their arthritic customers and ground up tiger bones for aspiring kung-fu masters. Go to any butcher shop in any Chinatown in the U.S. and you can buy, off the shelf, chicken and pig vagina which are made into soup to be consumed by women (presumably of reproductive age!) In every major city in China and Taiwan, you can find restaurants specializing in serving penises of every animal known to the Chinese. You can probably guess that they cater exclusive to male patrons. Who needs Viagra when you had tiger penis for dinner!

According to TCM, everything you consume, animal, vegetable or mineral have some medicine value attached to it and every Chinese growing up is supposed to know about it. The difference between mother/aunt/grandmother and a trained TCM herbalist is that the latter has a more encyclopedic knowledge about these properties and knows more exotic consumables; all of which will have the power to restore balance to your yin and yang and to make sure your Chi flow is unobstructed. Next time you are in any Chinatown, stop by an herbal store and marvel at the wall of small index-card size drawers, each containing a different medicine. Most of the contents are dehydrated plant parts (leaves, stems, flowers, fruits, seeds, roots) and fungi but there are also tiger bones, toad skin, sea-horse and seal penis just to name a few. Unfortunately this list of ingredients also includes many body parts of endangered species including rhinoceros horns, bear gall bladders, bear claws and tiger paws. Some ingredients are known to be toxic if the dosage is not dispensed without some precision like foxglove (digitalis) and ma-huang (ephedra). When the herbalist diagnoses your condition (and I use the word “diagnose” loosely) he will pick out a combination of herbs, nuts and dried organ parts to make up a potion. Sometimes he just picks a pinch or a handful from the drawers. Sometime, he may even have to weigh the ingredient – usually only the more expensive ingredients get weighed, not the ones that may have the most potency or side-effects if over-dosed! Then he wraps everything in white newsprint paper. (Cultural hint for barbarians doing business in China: white paper is only for wrapping medicine – never use white paper as gift warp – never!)  Then he will explain to you how to prepare the concoction when you get home – sometimes you have to boil them in water (for anywhere from just boiling for a few minutes to simmering for up to 4 or 5 hours.) Sometimes, a gold or copper coin is dropped into the boiling concoction if some metallic essence is called for to compliment the brew. Sometimes all the ingredients are put into the pot at the same time, sometimes different ingredients are added at different times.

Individual herbalists may give you different ingredients for the same condition or they may give you different preparation instructions for the same ingredients. I remembered very distinctly an incident when my father was quite ill with stomachache, high fever, and diarrhea. He could not hold down any food for a couple of days. His cousin heard about his problem and on the way to visit us, stopped by his favorite herbalist to bring my father some medication – yes, the patient need not be present as long as the symptoms can be described. Unbeknown to my mom that his cousin was coming over with medication, she too went to her own favorite herbalist, presumably described the same symptoms and came home with another version of a cure. While the herbs themselves were a little different, the instructions on how to prepare them were; how much water to use and when to take the extracted bitter tea was completely different. I remembered my mom and cousin comparing the open packages on the kitchen table and discussing the significance of the differences especially the preparation.  Rational thinking may have befallen the Chan household that day.  By the fourth day my father gave in to Western medicine and was immediately checked into the Queen Elizabeth Hospital of North Borneo to have his very inflamed appendix removed.

But what is a kid suppose to think about East verse West? A visit to a Western medicine doctor often ends with a painful shot in the arm or buttock. A painless visit to the Chinese herbalist is always followed by having to drink up a few cups of black vomit-inducing bitter brew when mom is done boiling it. Of course, it’s never fun to be sick. What I remember of my childhood visits to the Western doctors is the hypodermic needle (thicker and bigger in my memory that they probably really were) and my main memory of visits to the Chinese herbalists is the pulse reading. A visit to the herbal doctor always started with the obligatory pulse reading. The herbalist feels your pulse at your wrist with his index and middle fingers. Supposedly a well trained pulse reader will be able to tell a lot about your general state of health by knowing how well your blood is flowing just by feeling your pulse.  They claim that they can feel for any irregularity from which to make a diagnosis about the patient’s liver and kidney in addition to the heart. It’s as good as dowsing!

That the foundation of TCM is unscientific, irrational and not supported by any empirical evidence is obvious, but that does not, unfortunately, means that TCM will go the way of flat-earth geography or alchemy. It is a cherished belief and a source of pride for Chinese all over the over the world today. For the People’s Republic of China (PRC), TCM is a patriotic symbol, enshrined in their constitution, taught in universities and protected and promoted by government agencies at all levels, from the village governing council to the most inner sanctum of the Chinese Communists Party. Since the founding of the PRC, TCM is sacrosanct and next to criticizing party or politburo officials in public, dissing TCM is the sure way to provoke and incite the wrath of the State.

In October 2006 someone did dare to skewer the scared cow of TCM in China.  A professor at an obscure provincial university launched an online petition to seek removal of the special status of TCM from the Chinese Constitution and as the only officially recognized medical system in China. Professor Zhang Gongyao from Central South University in Hunan province quickly found himself the center of controversy for voicing quite mild and reasonable criticism of TCM. He basically appealed for some serious research to be done on TCM and to update some of TCM’s outdated concepts and views about the human body using scientific principles. For daring to question the ancient wisdom of his ancestors and the political expediency of the Communist Party, vitriolic condemnation from his countrymen and government was quick. He was cursed on websites and Chinese culture discussion forums on the Internet by Chinese all over the world and denounced as a traitor by the Chinese government. He was right on target in his criticism that: “TCM has no clear understanding of the human body, of the functions of medicines and their links to disease. It’s like a boat without a compass: it may reach the shore but it’s all up to luck.”

Professor Zhang should take heart that despite being given special status; TCM is losing its luster in the eyes of many Chinese at home and abroad. Even Chinese newspapers reported that today the number of TCM practitioners in China has decrease to a little more than a quarter of what it was from the beginning of the 20th century and the number of physicians in Western medicine practice has more than doubled in the same period. In the case of my immediate family, my father was sold on Western medicine after his bout with appendicitis and followed a year later when my then 12-year-old older brother was diagnosed with brain tumor by a British educated and London University trained Chinese neurologist. He endured a 4 hour open-skull operation followed by a 2-month stay in a severely ill children’s ward in a Hong Kong hospital run by the British government. That was 1962, before MRI, endoscope probes and modern electronic medical instrumentation. I guess the surgical scalpel makes a very convincing argument in favor of Western evident-based medicine.

Today in any Chinese communities throughout China and Asia, access to and acceptance of Western medicine is widespread. The attitude of most Chinese, even those who profess to believe in TCM, laud Western evidence-based medicine for its ability to make accurate diagnosis of the most complicated illness with even the most subtle symptoms.  Without access to blood chemistry and urine analysis, TCM diagnostic techniques for non-communicative patients like babies are confined to just looking at their skin tone and smelling their poop and urine. (Reader may recall the scene from the 1987 Academy Award-winning movie The Last Emperor with concerned court physicians smelling the emperor’s chamber pot.) They concede that TCM has nothing to offer for serious illness, infectious diseases, trauma victims, organ transplantation and cosmetic reconstructions. Many have delicately downgraded their support of TCM to the equivalent of taking daily vitamin supplements. They use TCM to tonify themselves by regular consumption of the right tonic herbal brew to keep themselves healthy and disease free. Many are like my parents after they have “seen the light” and would always take their kids to Western-medicine trained physicians whenever they were sick. However, they themselves took the occasional herbal tea when they felt the need to balance and regulate their bodies. But as much as they were sold on Western medicine, they found it very puzzling that a Western-medicine trained doctor could not do anything for cold or flu except to tell us to drink lots of fluid and go to bed whereas every TCM herbalist will swear up and down that they have the ultimate herbal brew to do the job!

My quarrel with TCM is that it is unscientific and the body of knowledge upon which it rests is outdated and flawed. We now have a very good understanding of the operation of our human body – not complete but fairly accurate – yet TCM still seeks to describe the anatomy and physiology of our body with unrevised knowledge from our scientifically ignorant past. It’s not just bad science, it’s not even science. TCM needs to be brought up to 21^st Century scientific standards – shed all the voodoo, put it to vigorous tests and evaluate the results. I too, subscribe to the truism not to throw the baby out with the bath water – but let’s find out if there is a baby in there!  When the ginseng root and the quintessential female herb dong-quai were studied scientifically for their alleged cancer-curing power, they were found not only to be ineffective but in fact encouraged the growth of some cancer cells. It is quite possible that TCM herbs may be effective for many illnesses and may have something to offer modern pharmacology, but the active ingredients present vary in concentration depending on the soil and climate conditions under which they are grown. This makes the dosage unreliable and even dangerous when prepared by primitive home brewing. Until a pharmacological process is applied to preparation of Chinese herbs in the form of extracting the active ingredients and calibrating dosage, herbal treatment cannot be admitted into the realm of 21st century medical “science.” Like Prof Zhang, I like to see a concerted effort made to study them scientifically and let the results speak for themselves. That’s how Western medicine has ascended to it position of respectability. Study, research and promote the chemistry and pharmacology of the herbs and relegate the magic and superstitions to folklore and religion.

The argument from antiquity in favor of TCM usually goes like this:  it’s been around N-thousand years (replace N with your favorite integer between 1 and 5) and so it must have worked well! The truth of the matter is that TCM has no scientific basis and has been developed over the years on a foundation of very flawed understanding of the human anatomy and physiology.  Historically, the pathetically low cure-rate of diseases plaguing the Chinese population with access only to TCM resulted in the evolution of a hyper-superstitious culture bent on seeing ghosts and goblins around every corner and behind every bush, too ready to take another life away.   The inefficacy of their medical treatments throughout history, in my opinion, is responsible for the Chinese culture’s obsession with superstitions associated with maintaining good health and longevity.  The list of superstitious do’s and don’ts are especially long when it came to childbirth, prenatal and postnatal care.  Please note that I am not talking about ancient history or even 100 years ago – I am talking about the persistence of these superstitions today in very modern Chinese communities in Hong Kong, Singapore, Taiwan and big modern cities in China.

To understand TCM, you do not need to understand chemistry, biology, anatomy or physiology because the foundation of TCM has nothing to do with them.  You need instead to understand Taoism and Confucianism, as these philosophies are the founding principles of TCM. I will expend some ink here to explain these two very powerful underlying influences on Chinese society which gave rise to their understanding of the human body and the attendant medical fallacies.

Taoism is a philosophical movement founded by Lao-Zhi .  In his canon, the “Tao I-Ching,” Lao-Zhi laid out what Chinese are taught as the “Tao” of life – translated properly as “the righteous way” of life.  Taoism asserts that because we humans are a part of nature, goodness and well-being comes from being in harmony with nature.  Nature was thought to be made up of five elements – water, fire, wood, metal (gold) and earth.  This led to the conclusion that we must have five organs and five orifices, each one associated with one of the five elements. The difference between living and non-living things in nature was thought to be in the presence of “vital energy flow” in living organisms and absent in non-living things.  This is “Chi” (or “Qi”) — which has been adopted by the New Age Movement as their ubiquitous pseudoscience jargon de jour.  Along with Chi, is the concept of maleness (strength, virility, bravery, intelligence and every sexist stereotype you can ascribe to men) and femaleness (gentility, compassion, intuition, nurturing and every sexist stereotype you can ascribe to women) which are enshrined in the principle of Ying and Yang. Every food, animal, plant, word, color, taste, and feel have varying degrees of Ying and Yang.

Taoism is the quest for harmony with the universe.  Life is good when you are in harmony with each other and with nature.  You are healthy when your Chi flows smoothly through your body and you consume food, do stuff, use words and think thoughts that will keep your Ying and Yang in balance.  Since everything ultimately comes from nature, we must all somehow be one with nature, animate and inanimate objects included.  From this cosmogony – and unencumbered by verification or falsification by any experimentation – other fantastic ideas about nature and how nature works spawned.  Taoism proposed many of the proto-scientific ideas found among early Greek philosophers like Aristotle, Epicurus, Pythagoras, and others. But while the West has long moved away from the five elements/five senses approach to understanding nature and pathology of illness, every classically trained TCM “doctor” still start out with the proposition that the kidney is water, liver is fire, stomach is wood, lungs are metal and heart is earth when diagnosing illness and dispensing herbal medication.  I will leave you to your imagination to associate our five orifices with the five elements! While there may be nothing wrong with adopting Taoism as a philosophy or religion, it was unmitigated disaster to use it to gain an understanding of the physical human body for medical purpose.

Why have the Chinese after thousands of years of civilization not developed the scientific method to examine and put to test all the “common sense” knowledge about nature they have been taught or acquired by intuition?  Blame it on the sage Kung-Zhi, anglicized as Confucius.  The teachings of Confucius saturated every aspect of the Chinese society but it is not a religion and barely a philosophy.  The teachings are basically a set of rules governing relationships and the “proper” conducts of every possible social intercourse.  Confucianism is concerned with the hierarchical relationships of emperors over subjects, masters over serfs, husbands over wives, parents over children, teachers over students … and the list goes on. Then there is the preference for symmetry over non-symmetry, intellectual work over manual labor, and common sense over logic. He promoted common sense and reasonableness as the hallmark of a scholar.  For Confucius, it is not enough that a proposition be “logically correct”; it must be in accord with “human nature.”  Between Taoism and Confucianism, all the necessary ingredients to incubate and foster critical thinking was “taught” out of the Chinese society.

The complexity of the human body and all its attendant diseases and ailments can neither be explored nor understood by mere intuition and common sense.  Advancement in medical science requires application of the scientific method and as we make discoveries we must have an avenue to replace past knowledge with more current ones even if we have to contradict our teachers.  When students cannot challenge inaccurate or flawed knowledge of the teachers, errors are passed on generations after generations and the quest for knowledge and understanding of nature is stifled. When scholars can only contemplate and make common sense guesses and did not roll up their sleeves to dig into the dirt to study earthworms or cut open dead bodies to study inner organs, wild speculation of the unseen part of nature resulted.  Common sense, intuition, reasonableness and the pursuit of harmony may be ideal for understanding humanity and settling human disputes but they are inadequate for determining the locations of our internal organs or understanding the life-cycle of earthworms.  Canonical knowledge from antiquity located the heart in the middle of the body (“symmetry”).  In the 1700’s, Jesuit missionaries first arrived in China bringing with them the latest anatomy books from Europe showing the heart to be on the left side of the chest cavity. Common sense led Chinese scholars to conclude that since Europeans look different (“inferior”) externally, they must also have defective placement of their internal organs, which they intuit gave rise to their different religion.  It was thought then that if the Jesuits succeeded in converting any Chinese to their religion, it must be because these converts have hearts on the left side like the Europeans and thus defective as Chinese.  The Chinese scholars of the day pitied the Jesuits for not knowing that they were only converting defective Chinese!  One can conclude that it must have been beneath the dignity of a scholar to hold his hand to the left side of his chest to feel for palpitation – that would be manual labor.

“But.. but.. but.. TCM does work sometimes..” I hear my detractors protest.  Well, yes it does – sometimes.  And here I am going to invoke the “it’s-been-around-N-thousand-years” defense.  TCM could possibly work sometimes (rarely) for the same reason that if you give a blind archer enough arrows and enough time (thousands of year?) it is not unreasonable to expect that he may hit a target or even a bulls-eye.  Would you trust your health and well being of yourself and your family to dumb luck and random chance?  Consider the fact that in its long history, and in spite of their professed love of children, the Chinese never developed a branch of medicine to take care of children.  When the prevailing unscientific common sense wisdom was that babies were just smaller version of regular people and cannot be that different in their medical needs there is no need for a specialty of pediatrics.  Thus terms for distinct periods of childhood development like “adolescent” and “puberty” are absent from traditional Chinese medical vocabulary.

Next week, I will continue in Part II to relate some personal experience I have with TCM while growing up and how TCM must be accompanied by a heavy dose of superstition to work properly.  That the foundation of TCM is utterly unscientific is obvious to those of us who grew up with it and later discover science and the scientific method.  In modern times some efforts have been made to subject many TCM herbs and modalities to vigorous testing for efficacy and side-effects. A lot of these efforts were undertaken by the People’s Republic of China (PRC) in their quest to promote TCM along side Western evidence-base medicine.  I will also comment on some of these efforts and why they are so politically sensitive about the subject.  Of the thousands of herbs commonly prescribed by “modern” TCM herbalists, a few have been found to actually do something.  The blind archer may have grazed the target a few times!  Modalities like acupuncture to treat various ailments from back pain to diabetes or “medical Qi-Gong” to treat cancer all turned out to be placebo at best. But yet TCM is making some headway in the U.S., for unfortunately in an increasingly scientifically ignorant society, the paucity of research-grade evidence is not a barrier for acceptance by the consumers as long as there are enough personal anecdotes in the form of “satisfied customer” testimonies.